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therefore, is a disgrace to so-called civilisation, and could be completely eradicated by effective sanitation. The typhoid poison may be conveyed in water, milk, and other fluids. Persons over fifteen and under thirty years of age are most liable to attacks of typhoid.

The symptoms chiefly met with in typhoid fever are the following:-Severe frontal headache, general aching pains in the limbs, lassitude, broken sleep, chilliness, nausea, anorexia, diarrhoea, and abdominal pain. The tongue is furred, and there is fever increasing towards the evening. These symptoms, which occur in the early stage of typhoid, are generally so well marked as to cause grave suspicion of an invasion of that disease. Later on, more characteristic symptoms appear, such as the circumscribed flush on the cheeks; the hot and dry, but sometimes moist skin; the accelerated pulse, 100 and upwards, weak and compressible; the enlarged papillæ of the tongue, which is coated with a yellowish fur, and is red at the sides and tip; the dry lips; the great thirst; the pain and tenderness, with gurgling in the right iliac fossa; the tympanitis; the frequent pultaceous stools; the intestinal hæmorrhage; the typhoid rash (lenticular and rose-coloured, coming out in crops, and disappearing on pressure); the delirious but sometimes apathetic condition; the sudamina and liability to bed sores; and the gradual but progressive emaciation and prostration; with collection of sordes on the lips and teeth.

There is a peculiarity of the temperature in typhoid fever, which enables the physician to diagnose it with certainty from all other pyrexial attacks. There is a very regular, but gradual ascent of the temperature for four or five days. The thermometer in the axilla indicates a rise per day of about 1°c. The evening temperature is 1°c. higher than that of the morning, and each morning the temperature falls °c. lower than the temperature of the previous evening; thus by the evening of the fifth day, the temperature is 39°c. to 40°c. After this

latter period, the evening temperature usually ranges between 40°c. and 41°c., and the remission in the morning may be

but slight. In some severe cases the thermometer may

register 42°c.

A consideration of all the symptoms enumerated, will dictate a rational plan of treatment. The intestine must be

cleansed and refreshed by the Seidlitz salt:-
:-

One small teaspoonful in a glass of water every morning from the commencement of the attack.

Thus the intestine will be cleared of the fermenting nitrogenous matters, and the serous exhalation produced will diminish the morbid heat in the interior of the body, for in typhoid the rectal temperature is often 10 to 2°c. higher than the surface temperature.

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To prevent tenesmus and diarrhoea, and at the same time a sedative and antiseptic, the following enema (chloral borate of Hébert) may be administered every day, or oftener if there is tenesmus:

Hydrate of chloral, 10 parts; borax, 5 parts; water, 250 parts.

Two teaspoonfuls of the solution can be added to an ordinary simple starch or gruel enema.

The body must be frequently sponged with cold water or solution of salicylic acid. In cases of high pyrexia, the cold bath may be necessary.

Phosphoric acid and strychnine (arseniate or sulphate) must be employed whenever there is prostration :

A granule of each, together, every hour or even half-hour, according to the degree of prostration.

As a rule, these remedies are required from the commencement, and may be associated with the defervescent alkaloids, if the temperature is high, and if at the same time there is great prostration. If convulsions or muscular twitchings occur (proof of extreme debility), the phosphoric acid and strychnine are particularly called for.

To reduce the temperature, aconitine and veratrine must be given:

A granule of each, together, every half-hour.

Their action on the temperature must be closely watched, so as to prevent shivering and collapse. If, however, the temperature remains obdurate, some focus of irritation in the intestine (ulceration, etc., of muciparous glands) may be suspected. In such a case, cold baths and sponging must be insisted on.

When the heat and pulse begin to oscillate; in other words, when the morning and evening temperatures become markedly different, and especially when the symptoms are aggravated, quinine is indicated :

One or two granules (arseniate or hydroferrocyanate) every half-hour.

If the urine is scanty or suppressed, digitaline and arseniate of iron must be given :—

A granule of each, together, eight or ten times a day.

Insomnia, restlessness, agitation and spasm, may be calmed by morphine and hyosciamine :

A granule of each, together, every half-hour, until sedation of those symptoms takes place.

It may be requisite to combine these two alkaloids with strychnine, so as to re-establish muscular antagonism.

It is necessary that the patient be well nourished as soon as possible, but great care must be observed in this respect as long as the skin is dry and hot. If, however, the patient sleeps well, and calm has been restored, digestion may be promoted by quassine:

Two granules three times a day, half-an-hour before food.

Good milk and beef-tea, thickened with arrowroot, and meatessences (Brand's), form the best articles of diet. Tea and

coffee may be allowed occasionally. Alcoholic stimulants are rarely required, and should be given with extreme care, as they often aggravate all the typhoid symptoms.

As reconstituents of the blood after the fever has ceased, the arseniates must be employed;-arseniate of soda or arseniate of iron :

Six granules a day.

It is not wise to let the patient imbibe too much of insipid drinks, as a condition of hydræmia is induced, and the circulation becomes embarrassed. The salicylic acid lemonade, employed in cases of typhoid in the Civil Hospital at Ghent, will be found a serviceable beverage. It is thus composed :

:

Salicylic acid, 4; tartaric acid, 4; simple syrup, 75; tincture of lemonpeel, 5; warm water, 920.

It can be taken like ordinary lemonade.

If the physician be called in at an early period of the disease, the fever can often be jugulated, and the various anatomo-pathologic lesions prevented. The Seidlitz salt every morning, to refresh and cleanse the intestine, and strychnine (arseniate or sulphate), aconitine and digitaline :A granule of each, together, every half-hour,

administered till the pyrexia ceases, will often be sufficient to arrest the evolution of the disease.

ORIENTAL PLAGUE.

This Eastern scourge is an affection analogous to typhus, since it is also of animal origin. It is chiefly characterised by the formation of gangrenous bubos in the groins, axillæ, and more rarely in the parotid regions; whilst, on the contrary, in typhus the latter are the seat of parotitis (mumps). In addition to the above, the adynamic and ataxic symptoms are the same.

Desgenettes, who had the opportunity of observing the plague in the Egyptian expedition, has divided it into three

varieties—the first, characterised by a slight fever with bubos; the second, by a more intense fever and bubos; the third by fever with delirium, gangrenous bubos, and carbuncles on the back, the buttocks, and in the abdominal wall.

These varieties or degrees, which mark the evolution of the miasmatic principle, would be mitigated by the dosimetric treatment. Without having had personal experience in this respect, I would advise the same treatment as in typhus :Seidlitz salt for cleansing the intestine, and arseniate of strychnine and arseniate of quinine to oppose the prostration and exacerbations :

A granule of each, together, every half-hour.

Soups, generous wines, and acidulated drinks* are required. The thermometric progress of the disease must be carefully noted; and if the animal temperature remains at 40° or 41°c., it must be reduced by aconitine and veratrine.

It will also be necessary to sponge the whole body with cold water, to which aromatic vinegar or salicylic acid solution has been added.

ERUPTIVE FEVERS.

The eruptive fevers are distinguished by their contagiousness, and some, like variola, are inoculable. It was formerly believed that the development or return of these diseases might be prevented in that way, but experience has demonstrated that their virulence does not the less exist. therefore became necessary that Jenner should undeniably establish the preservative virtue of vaccine.

It

The preservative power of vaccine lymph seems to extend to all eruptive and even exudative diseases; thus these diseases have become less frequent and less virulent since vaccination has been generalised.

*The salicylic acid lemonade, as recommended in typhoid fever, would be most valuable as a drink in plague, on account of its antiseptic properties. Zoedone, also, if it could be procured, might be allowed, as it is a valuable blood and nervine restorer.-H.A.A.

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